Rapidly rising PSA

Hi. After having a PSA of around 2.0 -2.5 for a number of years (I'm 61), last November it had risen to 13 and I just found out it it has now increased to 19. As I have been on antibiotics to rule out prostititus for the last four weeks, I believe the probability is now much greater that I may have an aggressive PC (which my brother had in his mid-50s).

Because of the holiday season here in Australia, there has been a two month delay between being referred and being able to see a recommended prostate cancer specialist (Urologist). I will be seeing him late next week. I'm just thinking through how things may proceed from when I see him. I assume he will recommend a biopsy as the next step. I'm also wondering, and this is where I would appreciate any thoughts, would it be worthwhile discussing with him (because it may be aggressive) having scans (eg MRI) if there is a delay in the biopsy as well as any preliminary drug treatment to slow things down while the diagnostics etc are done?

I am just making a wild guess, but if went from the 2.X's to over 10 in a year or less and then in a month to 19, that really sounds like an infection or some other factor involved. Your uro should be able to examine fluid from your prostate to check for infection. The fluid can be expressed by a very agressive digital exam. I might add, a none to pleasant experience. Hopefully you can clear this up and it is not PCa. good luck06-08 1st biopsy neg psa 4 10-09 psa 5.5 2nd biopsy 1/12 pos. 10%, G(4+3) age 6512-15-09 RRP Tulane NOLA Dr Lee Path, 1%, clr marg, no EPE, no SVI, nodes cl, G(4+3)100% incontinent @ 12 months ED, pre-op severe, post op total 10/10 Dr Boone, Methodist recomended AUSAUS/ IPP performed 1/11/11 Methodist Houstonpost op psa's 0.04,<0.1,<0.1,<0.01@12 mo.

A sudden big jump sounds like it could be an infection. Also hopefully your doc has been doing PSA tests before doing DREs and not the other way round as that can send your PSA up. (Mine jumped from 8.5 to 13 in a week which was clearly down to the biopsy and the DREs I had had - and when the next uro I was referred to saw that test result of 13 he threw it away!)

Regarding delays between seeing uro and having biopsy I was lucky. My GP said my PSA seemed so high that I needed a biospy as well as to se a uro, so when I phoned to maek an appointment to se the uro for the first time I said that it was to include a biopsy. And thus my GP also gave me the prescription in advance for the antibiotics so I could start taking them the day before I saw the uro. Perhaps you could call the uro in advance too to check if he might want to do a biopsy when you see him, then you could go prepared and save yourself a bit of time.

Perhaps some other folk in OZ can chip in with extra local tips relating to the OZ system.

Hi thanks for taking the time to provide feedback. It certainly is a rapid rise and it will be great if it is an infection! What makes me think it may not be is that antibiotics for the last four weeks had no effect and I am not aware of any recent changes / symptoms that suggest it is either acute or chronic prostititus but yes, it makes sense for the uro to get a sample of the prostate fluid for examination so be more sure of what is going on and to follow that up with a biopsy - so I'll make sure I talk about that with him. None of my PSA tests were done within a month of a DRE.

For those who live in NSW (Aus) any suggestions around who you think are the leading prostate cancer specialists - urologists, medical oncologists, radiotherapists. I am booked in to See Dr Phillip Stricker next week and am just getting my head around all this beforehand - just in case. Have found this forum as well as Walsh's book and the one by Blum and Sholz excellent.

Sobeit, Dr Philip Stricker, was highly recommended to me 2 yrs ago, and I am certainly very glad, I flew down from Qld. He is amazing and a wonderful surgeon, probably the leading man in Oz. So you are seeing the right man, and will certainly get the right answers to your questions. Just take a deep breath, and relax, your in good hands............Cheers Kev.Age 53yrs [Gold Coast Qld, Australia]PSA 4 Gleason 7 [3+4=7]RP 24/12/08 Dr Philip Stricker [Sydney]Upgrade Gleason Score 7.6 [4+3=7]Stage 2 Margin status- Focal InvolvementED- okay with Meds.PSA at 2 yrs, no change remains 0.03 "Everyday in Every-way I Get Better'

Only a good biopsy at this point can rule out cancer. My PSA almost tripled in the final year before it was dx, and at no point did I ever have any infection. I went through a total of 3 biopsies before it could be confirmed. Good luck, for you sake, I hope it is some kind of infection and not cancer.

sobeit,Looks like biopsy is in store as it doesn't seem to have responded to anti-biotics. I had mine done under sedation similar to colonoscopy so I knew nothing about it. Came out bright as a button -----wish I could have said the same for the results. Most here seem to have it done right there in the uro's office and reactions range from "is that all there is to it" to "Holy s*it, that's excruciatingly painful". Stricker, as Kev mentioned, has a very good reputation as does Raji Kooner in the same clinic. Both are robotic specialists but charge substantially more for the robotic procedure. Medicare will refund 75% of the cost of the standard open procedure and your health fund the balance up to 100% but only up to the amount of the medicare scheduled fee. This can leave you substantially out of pocket. Both normally operate out of St Vincent's Private but your in-hospital costs are fully covered if privately insured. Is there an advantage to robotic over open? Surgically in the hands of a very experienced doc I think not ------ recovery from external incisions may be a week earlier with robotic but the internal surgery is identical in both cases and will take the same time. Both those docs are very experienced in open surgery as well. I have also heard very good things about Paul Cozzi at St George in Sydney ------ open only there.Take care,Bill